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--Johns Hopkins Vice President One of the Donors

NOTE TO EDITORS: 90 sec. B-roll (.WMV format) of a previous kidney transplant is available upon request.

July 7, 2009-  Surgical teams at The Johns Hopkins Hospital, Barnes-Jewish Hospital in St. Louis, INTEGRIS Baptist Medical Center in Oklahoma City and Henry Ford Hospital in Detroit successfully completed the first eight-way, multihospital, domino kidney transplant. The transplant involved eight donors — 3 men and 5 women along with eight organ recipients — 3 men and 5 women. “All Johns Hopkins patients are in good condition and are recovering as anticipated,” according to Robert A. Montgomery, M.D., Ph.D., director of the Johns Hopkins Comprehensive Transplant Center.

The procedure, kidney paired donation (KPD), takes a group of incompatible donor-recipient pairs (recipients coming to one of the four hospitals with a willing donor who is not compatible by blood or tissue) and matches them with other pairs in a similar predicament. By exchanging kidneys between the pairs, it is possible to give each recipient a compatible kidney. In this way, each recipient receives a kidney from a stranger, and transplants are enabled that otherwise would not have taken place. Involving multiple hospitals created even more possibilities for matches, but it also made the procedure more complex.

“We performed a similar six-way domino procedure involving three hospitals earlier this year,” says Montgomery. “We managed to perform all those surgeries on the same day. However, adding two more recipients, two more donors and another hospital meant that we needed a multihospital team of eight anesthesiologists, 16 nurses and nine surgeons. The logistics being that much more complicated, we decided it was best to spread the surgeries over several days, the first on June 15 and the last, July 6.”

Aside from sheer logistics, performing large numbers of transplants on one day puts a lot of strain on the doctors, nurses and staff at each hospital, says Montgomery, and also ties up too many operating rooms.

He says this new model will serve as a blueprint for a national KPD program in which kidneys will be transported around the country, resulting in an estimated 1,500 additional transplants each year.


Pamela Paulk, vice president of human resources at The Johns Hopkins Hospital and Johns Hopkins Health System, took her work to the next level June 22 when she joined an elite group of humanitarians and donated a kidney to a needy recipient.

Paulk was part of the four-state; 16-patient kidney exchange orchestrated by Robert Montgomery, M.D., Ph.D., chief of the transplant division at Johns Hopkins. It was the largest such multiple donor-recipient exchange to date. These exchanges — so- called domino kidney paired donation — enable multiple donors and recipients to interchange kidneys so that each recipient can receive the kidney that best matches his or her blood and tissue type, thus helping to ensure that the kidney will have the very best chance of long-term survival.

The ultimate beneficiary of Paulk's generosity is Robert Imes, who received someone else’s kidney because of her donation. Imes is a painter at The Johns Hopkins Hospital whom Paulk got to know nine years ago during contract negotiations with Imes’ local union.

“We have been good friends for a long time,” says Imes.

Paulk says Imes’ kidney had failed three years ago but she only learned about it recently when he had to take 10 months off from work. She said Imes is a soft-spoken, kind and polite man, not the type who would complain a lot about his problems.

“When he returned to work,” says Paulk, “I asked him if there was anything I could do. He said, half joking, that if only I could give him a kidney. To his surprise, I told him I would—I don’t think he believed me.”

Imes says he was touched by her kindness. “Although, to be honest, I kind of shrugged it off. It is one thing to say you want to give a kidney and another to go through all the work it takes to actually donate one,” he says.

Paulk said she first thought of donating 10 years ago after meeting Montgomery at a party. They talked about the need for organs and that most people carried around a spare kidney that could save someone’s life. Montgomery even invited Paulk to witness a surgery, which she did.

“There is a magical moment in the procedure when you can actually see the kidney begin to function. It had a powerful effect on me,” says Paulk.

She was so moved by this experience that she became a supporter of kidney donation and began speaking at small events at Hopkins to raise awareness. The incongruity of a national kidney shortage when, theoretically, there is ample supply, compelled her to want to donate some day. She says she was just waiting for the right time.

“I felt like, if you believe in this, you have to be willing to do it yourself,” she says.

She says there was no defining “aha” moment when she decided she was ready. “I just reached a point where I thought that I should do it while my kidneys are healthy,” say Paulk. “And then I met Robert and I guess it was just time.”

Shortly after Paulk learned of Imes’ desperate need, she went to the Johns Hopkins Comprehensive Transplant Center and said she wanted to donate her kidney to Imes. Testing soon revealed the she and Imes did not have the same blood type and he could not receive her kidney. When she called Montgomery and asked if there was any way she could help Imes, he told about domino kidney paired donation. When he explained that this procedure not only guaranteed Imes the best kidney but would also benefit a lot more recipients, she did not hesitate to sign up.

“As strange as it might seem, my only real fear was the anesthesia,” says Paulk. “My mother was in nursing training back when anesthesia was very risky, and she always warned me against anesthesia.”

Paulk says what helped her make the final commitment was a conversation she had with her friend John Ulatowski, chairman of the Department of Anesthesiology.

“When I told him my fears, he laughed and said, ‘You’re about to have major surgery, and you’re concerned about the anesthesia? Get over it.’”

It might not have been the most comforting of responses, but Paulk says it did the trick.

Paulk joins roughly 100,000 Americans since 1988 who have generously donated a kidney to needy recipients, according to data from the United Network for Organ Sharing (UNOS) Web site. As encouraging as that sounds, 84,000 people in the United States alone are listed in 2009 by UNOS as needing a kidney. With only 6,000 people donating kidneys in 2008, we are a long way from eliminating this problem, says Montgomery.

Paulk says she is happy and at peace with her decision and plans to continue to be a vocal advocate for kidney donation.

“I am already telling everyone I see, do you know you have two kidneys and only need one?

An altruistic donor started the domino effect. Altruistic donors are those willing to donate a kidney to any needy recipient. Just like falling dominoes, the altruistic donor kidney went to a recipient from one of the incompatible pairs, that recipient’s donor’s kidney went to a recipient from a second pair and so on. The last remaining kidney from the final incompatible pair went to a recipient who had been on the United Network for Organ Sharing (UNOS) waiting list.

One of the donors in this procedure was the Pamela Paulk, the vice president of human resources at The Johns Hopkins Hospital and Johns Hopkins Health System. Paulk, a long-time supporter of kidney donation, decided to donate to a friend and colleague who lost function of his kidneys three years ago.

“I always knew I was going to donate. I was just waiting for the right time, and this was the right time,” says Paulk, whose surgery took place on June 22. Paulk joins roughly 100,000 Americans since 1988 who have generously donated a kidney to needy recipients, according to data from the UNOS Web site. As encouraging as that sounds, 84,000 people in the United States alone are currently listed by UNOS as needing a kidney. With only about 6,000 people donating kidneys annually, we are a long way from eliminating this problem, says Montgomery. For an up-to-date perspective from Paulk, please visit  

As part of this complex procedure, Johns Hopkins flew one kidney to Henry Ford, one kidney to INTEGRIS Baptist and one kidney to Barnes-Jewish, In exchange, Henry Ford, INTEGRIS Baptists and Barnes Jewish each flew a kidney to Johns Hopkins.

The 16 surgeries were performed on four different dates, June 15, June 16, June 22 and July 6. The 10 surgeons in charge included four at Johns Hopkins, two at INTEGRIS Baptist, two at Barnes-Jewish and two at Henry Ford.

Johns Hopkins surgeons performed one of the first KPD transplants in the United States in 2001, the first triple-swap in 2003, the first double and triple domino transplant in 2005, the first five-way domino transplant in 2006 and the first six-way domino transplant in 2007. Johns Hopkins also performed the first multihospital, transcontinental three-way swap transplant in 2007 and the first multihospital, transcontinental six-way swap transplant in 2009.

Nearly 100 medical professionals took part in the transplants, including immunogeneticists, anesthesiologists, operating room nurses, nephrologists, transfusion medicine physicians, critical care doctors, nurse coordinators, technicians, social workers, psychologists, pharmacists, financial coordinators and administrative support people.

The other surgeons who participated in the surgery were Mohamad Allaf, M.D., Andrew Singer, M.D., and Dorry Segev, M.D., from the Johns Hopkins Department of Surgery; Scott Samara, M.D., and Shea Samara, M.D., from INTEGRIS Baptist Medical Center; Surendra Shenoy, M.D., Ph.D., and Martin Jendrisak, M.D., from Barnes-Jewish Hospital; and Dean Kim, M.D., and Lauren E. Malinzak, M.D., from Henry Ford Hospital.

For additional information about this procedure, the Johns Hopkins Hospital Transplant Division and UNOS, visit:

Johns Hopkins Medicine

Comprehensive Transplant Center

Graphic of transplant matches:

Surgeon Biographies

Pamela Paulk podcast:

KPD by state:

Related journal articles:

Johns Hopkins Leads First 12-Patient, Multicenter “Domino Donor” Kidney Transplant, Feb. 16, 2009

"Six-Way Domino" Kidney Transplant press release, April 8, 2008

Quintuple" Kidney Transplant press release, Nov. 20, 2006

Other transplant press releases:

United Network for Organ Sharing

Media Contact: John Lazarou
410-502-8902   ;
[email protected]